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BLOCK I: Pharmacotherapeutics > Exam 1 Acneiform Disorders > Flashcards

Exam 1 Acneiform Disorders Flashcards

(68 cards)

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1
Q

general concepts of acne treatment

A
  • There is no cure

- Don’t forget patient expectations (as with all diseases) and discuss preventive measures

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2
Q

things to address with acne

A
  • Discomfort
  • Appearance
  • Long-term scarring
  • Psychological stress
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3
Q

Acne is believed to result from a combination of:

A
  • Sebaceous gland hyperplasia
  • Follicular hyperkeratosis
  • Propionibacterium acnes colonization
  • Inflammation
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4
Q

What is drug therapy aimed at?

A

1 or more of the mechanisms:

  • Sebaceous gland hyperplasia
  • Follicular hyperkeratosis
  • Propionibacterium acnes colonization
  • Inflammation
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5
Q

Non-drug therapy

A
  • Avoid contributing factors when possible
  • Counsel pt that acne is NOT poor hygiene
  • Simple washing with water/mild cleanser BID is enough
  • Advise pt not to squeeze/pick
  • Avoid oil-based products
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6
Q

MOA of topical retinoids

A
  • Vitamin A analogs that work by stimulating epidermal cell turnover which unplugs follicles
  • Inhibit production of inflammatory mediators
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7
Q

Preferred first-line agents in mild-moderate acne either alone or in combination

A

topical retinoids

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8
Q

Should be used as part of combo therapy for moderate-severe acne

A

topical retinoids

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9
Q

First-line to maintain remission

A

topical retinoids

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10
Q

should use sunscreen because new skin burns easily, use moisturizer in combo

A

topical retinoids

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11
Q

use topical retinoids at night because drugs are _____

A

use topical retinoids at night because drugs are photolabile

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12
Q

Original tretinoin should avoid use with ______ _______

A

Original tretinoin should avoid use with benzoyl peroxide

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13
Q

skin irritation including stinging, redness, dryness

A

ADRs of topical retinoids

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14
Q

topical retinoid drugs

A
  • Tretinoin (Retin-A)
  • Tazarotene (Tazorac)
  • Adapalene (Differin)
  • Adapalene + benzoyl peroxide (Epiduo Forte Gel)
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15
Q

Possibly more effective but more irritation

A

tazarotene (Tazorac)

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16
Q

Contraindicated in pregnancy – don’t use in females 10-50

A

tazarotene (Tazorac)

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17
Q

Less irritation

A

adapalene (Differin)

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18
Q

July 2016: Approved for OTC 12+ years old

A

adapalene (Differin)

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19
Q

Come in a variety of dosage forms (gels, lotions, creams, swabs, cleansers, etc.)

A

topical retinoids

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20
Q

MOA of benzoyl peroxide

A

Antibacterial (releases oxygen free radicals that damage cell wall) and keratolytic (exfoliates and opens pores) properties

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21
Q

Often in combo with other antibiotics to reduce resistance (bacteria have no way to produce resistance to above mechanism of action)

A

benzoyl peroxide

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22
Q

Available OTC so often used first-line as monotherapy

A

benzoyl peroxide

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23
Q

Can cause bleaching of skin

A

benzoyl peroxide

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24
Q

Avoid overuse (mostly once daily)

A

benzoyl peroxide

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25
Skin irritation | Dryness and peeling of skin
benzoyl peroxide
26
topical antibiotics for acne
*Erythromycin *Clindamycin Sulfacetamide Sulfur & Sulfacetamide Dapsone
27
other treatment failure of mild acne
topical antibiotics
28
Moderate acne (usually in combo with other topicals)
topical antibiotics
29
MOA for Azelaic Acid (Azelex)
- antimicrobial, comedolytic, anti-inflammatory properties | - Normalizes keratinization and suppresses P. acnes
30
Touted to cause less irritation so you might chose first-line for very sensitive skin
azelaic acid (Azelex)
31
Downside is that it is usually less effective than other topicals and expensive
azelaic acid (Azelex)
32
Also indicated for Rosacea (specific product form)
azelaic acid (Azelex)
33
- Reported cases of hypopigmentation | - $$$
azelaic acid (Azelex)
34
Local skin irritation
ADR of azelaic acid (Azelex)
35
MOA of salicylic acid
Produces desquamation of hyperkeratotic epithelium
36
Salicylic acid is ______ at concentrations of 3% to 6%; it becomes ______ to tissue at concentrations >6%.
Salicylic acid is keratolytic at concentrations of 3% to 6%; it becomes destructive to tissue at concentrations >6%.
37
what are concentration of salicylic acid at concentrations of 6-60% used for?
- remove corns and warts | - in the treatment of psoriasis and other hyperkeratotic disorders.
38
- Less effective v. benzoyl peroxide - May use second-line if other comedolytic agents haven’t worked - May be in combo with other agents
salicylic acid
39
local skin irritation
ADR of salicylic acid
40
what PO antibiotics should you usually start with
minocycline or doxycycline
41
second-line options for PO antibiotics
- TMP-SMX - Azithromycin - Erythromycin - Clindamycin
42
usually for moderate-severe acne
PO antibiotics
43
when do you check patient back for efficacy when using PO antibiotics
6-8 weeks
44
How long do you try to limit duration of treatment for PO antibiotics?
12 to 18 weeks to limit resistance
45
Dosed with topical retinoid and/or benzoyl peroxide to improve efficacy and reduce resistance
PO antibiotics
46
Estrogen is an ____-_______ agent
Estrogen is an anti-androgen agent
47
for moderate-severe acne
oral contraceptives
48
Only indicated for severe, recalcitrant, nodular acne
isotretinoin
49
Option for management of acne that is producing either physical or psychological scarring
isotretinoin
50
Used in a variety of other skin diseases such as ichthyosis and some cancers
isotretinoin
51
***ORAL ISOTRETINOIN IS A POTENT _________***
***ORAL ISOTRETINOIN IS A POTENT TERATOGEN***
52
Female patients of ____-_____ potential must only be treated with oral isotretinoin if they are participating in the approved pregnancy prevention and management program (______).
Female patients of child-bearing potential must only be treated with oral isotretinoin if they are participating in the approved pregnancy prevention and management program (iPLEDGE).
53
Male patients must enroll in ______ as well as some amount of drug is found in ______.
Male patients must enroll in iPLEDGE as well as some amount of drug is found in semen.
54
Mood disorders, depression, suicidal ideation, and suicides have been reported in patients taking this drug. However, a causal relationship has not been established.
isotretinoin
55
Chronic, relapsing inflammatory skin disorder with exact cause unknown
rosacea
56
possible causes of rosacea
- Innate immunology - Microorganisms (Demodex folliculorum, Bacillus oleronius, etc.) - UV radiation - Vascular hyperreactivity - Genetics
57
clinical features of rosacea
- Facial erythema - Telangiectasias - Inflammatory skin lesions
58
No cure known so treatment focus is on symptom suppression
rosacea
59
4 types of rosacea
- Erythematotelangiectatic rosacea – red blood vessles - Papulopustular rosacea – pus filled papules - Phymatous rosacea - nose - Ocular rosacea - eye
60
non-medical treatment of rosacea: avoid triggers of flushing
- Extremes of temperature - Sunlight - Spicy foods - Alcohol - Exercise - Acute psychological stressors - Medications - Menopausal hot flashes
61
non-medical treatment of rosacea: skin care
- Frequent skin moisturization - Gentle skin cleansing - Avoidance of irritating topical products
62
medical treatment for rosacea
- light therapy | - drug therapy - topical or systemic
63
Especially good for telangiectasias
laser therapy
64
first line treatment treatment in rosacea
``` Topical brimonidine (Mirvaso) - Topical alpha2-adrenergic agonist *Causes direct vasoconstriction ```
65
second line treatment in rosacea - topical
- usually for mild-moderate disease or failed other therapies - Metronidazole, azelaic acid, doxycycline
66
second line treatment in rosacea - systemic
- for more severe/inflammatory lesions or for those where topicals fail - Doxycycline or minocycline
67
for refractory cases of rosacea
isotretinoin
68
if rosacea has ocular involvement...
refer to ophthalmology

BLOCK I: Pharmacotherapeutics (9 decks)

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